Ms. T., 75, came to see me for therapy after a man stole her purse. He was in a car and lured her over under the guise of asking directions. Then he grabbed her bag and stepped on the accelerator. She was dragged halfway down the block before she let go. When I saw her a month later, she was still in physical pain from her injuries and emotional pain from having endured a traumatic experience.
Ms. T. had raised three successful children as a single mother, while enjoying a prosperous career as the head of a social services agency. She had gone through difficult times before, but she’d always been able to overcome them. Now she was embarrassed that she hadn’t been able to “get over” what had happened. She didn’t want to show her adult children her “weakness” and lean on them for support. She believed in therapy, in theory, but was ashamed to be the one who needed it. She no longer saw herself as the “strong black woman” she had once been.
This Strong Black Woman is a cultural icon, born of black women’s resilience in the face of systemic oppression that has dismantled families and made economic stability a formidable challenge. She is self-sufficient and self-sacrificing. She is a provider, caretaker and homemaker. And often, she is suffering.
I provide therapy to people from all socio-economic and racial backgrounds. I am the only black female clinical psychologist on the faculty of the department of psychiatry at Northwestern University, and black women often come to me in secret, feeling alone and embarrassed. They come despite friends and family telling them to “just pray.” They come because they are “desperate” and “can’t take it anymore.” I often get requests for informal consultation via email, LinkedIn, even Facebook. They’re skeptical about mental health treatment. They don’t want therapy, just to talk, and maybe get some advice.
Even in the confidential safe space of therapy, they cling to their public image of strength. They don’t realize that there is a secret community of Strong Black Women who share their distress.
Many — myself included — wear the badge of Strong Black Woman with honor. We are proud of our tenaciousness and never let the world see us crack. But we are suffering silently with the mental and physical health consequences of carrying the burden of family, work and community responsibilities, compounded by personal experiences of trauma and loss, all in an environment of pervasive racial and gender discrimination
Black women are more likely than white women to have experienced post-traumatic stress disorder resulting from childhood maltreatment and sexual and physical violence. They are more likely to have stress related to family, employment, finances, discrimination or racism and safety concerns associated with living in high crime neighborhoods. Black women are more likely to be depressed and when they are, their symptoms are more severe, last longer and are more likely to interfere with their ability to function at work, school and home. Black women are more likely to have feelings of sadness, hopelessness and worthlessness.
And yet fewer than 50 percent of black adults with mental health needs receive treatment. Shame is a key barrier. Black women also often prefer a black mental health care provider, and there are too few black social workers, psychologists and psychiatrists. In low-income communities, mental health services are scarce and waiting lists are long. And finally, more than 16 percent of black women are uninsured, and many can’t afford treatment.
Meanwhile, the psychological wear and tear of being a Strong Black Woman takes a toll on the mind and body.
Traditionally, black women have garnered strength from God. The church provides a place for fellowship, social support and spiritual guidance. However, the black church has not always condoned secular mental health care and churchgoers may feel that their faith is called into question if they seek extra help.
In lieu of therapy, some people cope with their distress through eating unhealthy foods and overeating, smoking, drinking alcohol and spending excessive time in bed or watching television. While these behaviors may provide temporary relief, stress and depression can emerge in the form of irritability, anger, physical pain and chronic illness.
Stress and depression are closely linked to chronic health conditions such as obesity, diabetes and hypertension — all more prevalent among black women. Their life expectancy is three years shorter than that of white women (81 versus 78 years).
Ms. T. reminded me of my grandmother, who moved to Chicago from Montgomery, Ala., as a single mother to escape an abusive relationship with an alcoholic husband. She lived in the Jane Addams housing projects, worked as a seamstress by day and attended Herzl Junior College at night. She worked her way off public assistance, earned bachelor’s and master’s degrees, and saved enough money to pay for my Ivy League education. She, too, had once been robbed and came home with the straps of her purse as evidence of the struggle. My grandmother was the quintessential Strong Black Woman.
But what about her struggles, her sadness and fear? I’m sure she experienced them. But we never talked about it.
Many of us have been conditioned to believe that we must be strong to survive. But we cannot hold up the strength of black women without acknowledging the stress that comes with it. Otherwise, we set unreasonable expectations for what black women should be able to endure.
There has recently been a shift in this direction. Groups like Black Girl in Om and GirlTrek are raising awareness about the importance of self-care and providing outlets for living a healthy lifestyle.
We must let go of the singular narrative of what it means to be a Strong Black Woman. Black women have harnessed their strength out of the necessity to support themselves and their families when no one else would — and that should be applauded. But there is also strength in vulnerability, comfort in seeing that you are not alone and power in knowing when to ask for help.
Inger E. Burnett-Zeigler is an assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.